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>> Good afternoon.
Hello and welcome to this lunch hour lecture,
which is given by Allen Hackshaw.
It's a lecture-- Professor Allan Hackshaw
from the UCL Cancer Institute.
It's a lecture entitled, "Cigarettes:
The most successful product ever?"
Thank you very much.
>> Professor Allan Hackshaw: Good afternoon everybody
and thanks for coming.
I wasn't sure whether the title was going to market cigarettes
because I use the word successful product ever
and I've got a feeling it is.
After all these years
of research it's still heavily engrained in practice.
A friend of mine in Italy a few weeks ago went to see his doctor
with some minor heart palpitations and his GP said
to him, "I think its stress that's the problem with you."
He then went into his pocket and pulled out a cigarette and said
to him, "I think you should take some of these
and that will calm you down."
This is his doctor during a consultation in 2013.
How can this not be the most successful product ever?
So what I'm going to cover is I'm not going to talk
about cancer and heart disease
because everybody knows what that's about.
But, I'm going to give the bigger picture
of the tobacco problem and touch on some disorders that aren't
so well known and also what happens next
or what should happen next.
So here, let's create a new product.
If this were to be a new product now
with these attributes they look really good.
It can relieve stress, so even doctors still think it does so,
gives you pleasure, can enhance your socializing,
look and make you feel more confident.
These are all features that most people want to have.
So if you've got a product
that can make you have these features then excellent.
So it looks like we're on a roll with these products.
These are iconic photographs
from when I was growing up many years ago.
This-- the people inside the pictures might have changed,
but the look of them haven't.
And if you go elsewhere in the world they look very similar.
So there's Marlboro man and there's Lauren Bacall
who I always think of smoking a cigarette almost every time I
see her in a film.
Again, how do you get this innocuous looking thing being
attractive, make you feel sexy whether you're a man or a woman?
There's not many products that can do that by the way
and it's all from branding and look how small this thing.
But, look at those two, okay, when you look at the imagery
of it and this is what the tobacco industry relies
on all throughout the years to make you think you can look
like one of these two people.
Remember Marlboro man, I'm going to mention him later on.
Look how fit and healthy he looks.
[Laughter] So consumers, you've created this product
that makes lots of people feel really well.
How popular could it be?
Well this is how popular it is,
it's 1,000,000,000 smokers in 2010.
That's one in five of the world's population.
It's absolutely huge, 800,000,000 men
and 200,000,000 women and in many countries the prevalence
of smoking women is going up.
This is what the tobacco industry say,
it was few years ago.
"If you can market a product that kills people,
you can market anything."
Do you agree?
I think so.
Again, I still think this is the most successful product ever.
And this is only-- this is not 1980's or 1990's.
This is only 2003, so even then the tobacco industry knows
that there are lots of mugs out there,
so if you'd pardon my expression.
But, remember that 1,000,000,000 smokers
in the world in one year.
So if you've got a product you could make to look attractive,
you can market it well.
What about the money it brings in?
Well in the U.K. alone its 15,000,000,000 pounds
of revenue.
That's in one country.
The U.K. is quite good at manufacturing it
by the way and selling it off.
They can't grow tobacco as you all know, but they're good
at manufacturing and sales.
In the United States 8.5 billion pounds spent just on markets
and advertising by the tobacco companies compared
to only 457,000,000 spent
on tobacco control by the government.
So just by looking at the disparity
between what the industry spends and what governments do to try
to counteract that is absolutely huge.
This is what I find staggering.
The largest six tobacco companies, their revenue
and profits, okay, look at the scale.
So these are the-- this is in one year alone by the way.
If this was looking at millions you'd think quite a successful
company wouldn't you.
The scale is not in millions, it's in billions of dollars.
It's absolutely huge.
So even after decades of tobacco research and everybody knows
about smoking and everybody knows a smoker,
I'm still staggered by the scale of this product
and how many people use it
and also how much money it makes the companies that produce it.
So this is just the six biggest tobacco companies.
The one that is more startling as you can see is the one right
on the right, one from China.
It's almost 92,000,000,000 dollars revenue.
That's where the tobacco companies are marketing.
And I and others when I starting work in smoking
about 20-22 years ago people --
we knew then that's what the future is for tobacco.
It's not in the U.K. or Europe or America.
It's in the developing countries where health education is not
so good as it is here.
So total revenue of those six companies, 346 billion dollars.
It's mind boggling, 35,000,000,000 dollars
of profits, so that should be dollars.
The profit from those six tobacco companies is the same
as the combined profits from McDonald's, Microsoft
and Coca Cola in that one year alone.
And if you think how common those products are,
well tobacco is even more popular.
And just put it in the scale of things, the amount of revenue
that those six companies made was not far off
from the Gross Domestic Product of Venezuela, a whole country.
So these big numbers I find so truly startling
after all these years.
So that's what this product has done.
It's been marketed incredibly well.
Their lawyers, their marketing people I think are amongst the
best if not the best in the world from any organization
because of the product they have to deal with, but at what cost?
They're expensive and in many countries the cost of them,
cigarettes is getting higher and higher.
So in the U.K., for example, a smoker who smokes about 15
to 20 cigarettes per day,
and that's what an average smoker smokes,
can spend easily 2 to 2,600 pounds a year.
That's not a negligible amount of money at all.
There's a clear social divide between rich and poor
and I'll show this a bit more.
Here's some in New York where they found that 25 percent
of the income spent
by low income workers is spent on buying cigarettes.
That's a huge amount of your salary
if you're not earning very much in the first place.
And again, it's another part of societies
where they're developed or developing countries
where the tobacco industry tries to focus.
It's not when people who know about the health aspects
so much, but people who don't know as much.
So these are some results
from the U.K. This is the average tobacco duty paid per
household over time, from 1995 to the year 2010.
And here we're looking at people in the bottom fifth of incomes,
so they're the poorest ones in society versus the ones
from the top fifth of incomes.
They're the richest ones in society.
And as you can see that blue curve has steadily gone
down over time, such that between 1995
and 2010 the richest people are now spending 31 percent less
on cigarettes.
But, the poorest people have only reduced their spending
by about 14 percent.
So a huge difference between the very rich and the very poor
in the U.K. and you'll see this pattern
in other developed countries as well.
So over time people have been smoking less.
There have been fewer smokers,
but people who are richer are smoking even more less
than ones who are not so rich.
So here are the health effects.
I'm not going to go into cancer and heart disease as I said ,
but here's a statistic that's well, fairly well known is half
of lifelong smokers die from their habit.
Not die from heart disease, cancer and a whole range
of things, but they die
from those things plus other stuff as well.
But, half of them die because of their smoking habit and many
of them die in middle age.
And middle age now really is in your, is your 30's
and 40's up to your 50's.
And one in five deaths in the U.K. alone is due
to cigarette smoking, so a 100 to 120,000 a year.
So if you think of that half it's
like playing Russian roulette with three bullets.
So none of us here would even play Russian roulette
with one bullet, I should hope not.
So if you imagine playing Russian roulette,
but putting three bullets in.
So you start smoking from the age of say 16-18 years old
and you get to 50-55 years old.
You spin the wheel of the gun and then you press,
that's what cigarette smoking is like.
So not trying to be too much of a scare tactic,
but these are very well established figures.
In the world, in worldwide completely there are 6,000,000
deaths in 2011 and 80 percent of those deaths were from the low
and middle income countries.
So I said a few minutes ago this is
where the big tobacco companies are starting
to focus their efforts.
To put into scale of things in terms of what else,
what other I suppose bad habits you could have
and whether you die from it or not, this is over 2004 to 2002
and 2004, so over a five year period
in the U.K. this is the number
of deaths attributable to three habits.
So you have smoking, alcohol and drugs
and that drugs is all drugs including illicit drugs,
so a tiny number down there.
I'm not advocating drugs by the way;
I'm just telling you the scale of things.
So drugs is just-- you can barely see it on this scale.
It's just down at the bottom.
Then you've got alcohol and that's 25,000 is the minimum,
maximum 200,000 so even the upper estimate
of the amount caused by alcohol drinking is only 200,000 deaths
in that five year period and look
at the number due to cigarette smoking.
It's way at the top.
It's way bigger than anything else you can imagine.
So what else does smoking do for you?
Well if you continue throughout your whole life you loose
on average by about 10 years of life.
This is a famous study from the British doctor's study.
The U.K. is in a good position in that in the early 1920's
and 1930's most of the population smoked
and it's the first country where most of the population smoked
and then in the 60's and 70's most
of the population quite smoking.
So U.K. figures are a good way of looking at what happens
when lots of people continue smoking for long periods of time
and what happens when they quit and I'll show you that later on.
So that red curve is the death rate for people
who have never smoked cigarettes and that blue curve is the curve
for people who have been lifelong smokers all the
way throughout.
And as you can see, from about the age of 50 that's when cancer
and heart disease starts to kick in and as soon
as you hit 50 the risks starts to separate out.
So people start to die off much quicker if you continue
to smoke compared to ones
who have never smoked a single cigarette.
So on average you can lose by about 10 years of life.
Many smokers if not most smokers, and I've got friends
who are smokers, think that their risk
of any disease is proportional to how much they smoke.
So everybody-- you all a smoker
that says oh I only smoke one cigarette a day
or I only smoke a few so I think it's okay.
That only applies to cancer.
With cancer there's a linear line between risk
and how much you smoke, but there isn't for heart disease
and probably stroke and this is what I'm going to be looking
at next in the next year or so.
So as you smoke more the risk of you getting heart disease jumps.
It doesn't go up slowly.
It jumps a lot and then it starts to level off.
Whereas with cancer it looks more like a straight line
and then it levels off much later.
And heart disease and stroke are one of the most,
two of the most common disorders you can get as well as cancer.
So let's quantify what the effect is.
So this is the effect of smoking one or 20 cigarettes a day
of getting heart disease.
And you-- because heart disease risk changes with your age its--
here it is by age group, 45, 55, 65 and 75.
So if you smoke one cigarette a day, that's one,
your risk of getting heart disease is almost double
that compared to a never smoker.
So that's where that relative risk of 1.93 is.
If you smoke 20 cigarettes a day and you're aged 55 your risk
of getting heart disease is three times greater,
hence the relative risk three.
So let's put the two risks in comparison with each other.
The risk of smoking-- the risk of getting heart disease
if you smoke one a day is 20 percent of seven percent
of the risk if you smoke 20 a day, okay.
So if you smoke one cigarette versus 20 that's five percent
and most people think I'm only going
to have five percent of the risk.
It's not true with heart disease and I think stroke.
It's not five percent, it's 27 percent of the risk
if you're age 45, but as soon as you get to 55
or 65 the risk is much higher.
To put it into context that relative risk
in those two columns for lung cancer it's about 20, okay.
So you're 20 times more likely to get lung cancer if you smoke
than if you don't smoke.
But, for heart disease even heavy smokers their relative
risk is only four to five times greater than a nonsmoker.
So smoking one a day actually gives--
that's where you get a lot of your risk and then
as you smoke more than that then you get some more.
But, then it's not just a small amount
of risk in smoking one a day.
So this is one fact that many smokers don't realize.
So as well as this extraordinarily high risk
of getting heart disease
for smoking very few cigarettes a day there's a whole host
of other disorders that smokers can get that are chronic.
So that most people focus on the serious and fatal ones,
ones that are going to kill you, there's a whole range of things
that aren't going to kill you and they're going
to be chronic disorders that you live--
that you have for most of your life.
So just to give you a flavor of some these,
actually a few slides of them,
these are so gastrointestinal disorders.
And you've got peptic ulcer, so you've got 100 percent increase
in risk if you're a lifelong smoker compared
to if you are a nonsmoker.
So in 100,000 smokers one could expect 440 of those
to be due to peptic ulcer.
You've got Crohn's disease, you've got gall bladder disease,
psoriasis for the skin, once you get it because a lot
of adults do get that and it's quite difficult to get rid of.
So a 40 percent increase for men, 150 percent increase
for women and in every 100,000 smokers those
who do get psoriasis 730 could be due to smoking,
2,000 if you're a woman.
So I'm not going to through these numbers in great detail,
but the flavor of the range of chronic disorders
that you can get if you smoke.
It's got neurological disorders, Alzheimer's.
Many years ago people thought
that smoking cigarettes was protective against Alzheimer's,
i.e. the more you smoke you were less likely to get Alzheimer's.
It's not true.
It's the way those studies were analyzed and interpreted.
Smoking cigarettes actually increases your chance
of getting Alzheimer's.
And one of the few things it does protect
against is Parkinson's, but you don't want
to think I want Parkinson's at the expense of other things.
Hip fracture quite common in elderly women and elderly women
who smoke are particularly prone to getting hip fractures.
You've got type 2 diabetes.
You've got overactive thyroid, periodontitis,
things with the teeth.
There's almost every body system that you can think
of is affected by smoking some way
and there's no big surprise considering
that smoking has got 6,000 chemicals in it.
It's bound to give you something very nasty if not several things
and smoking can directly harm other people around them.
The smoking ban came into place a few years ago and it's based
on the evidence on lung cancer with a 25 to 30 percent increase
in risk and for heart disease, 30 percent increase in risk.
But, plausibly any disorder that acts
of smoking causes a nonsmoker can get
if they're regularly exposed to passive smoke, okay.
So it's not just heart disease and lung cancer,
which is what most people think of, but it's any disorder
that I've listed plus all those other cancers you can
plausibly get.
The thing with smoking the risk goes up and it goes down,
so if you have passively smoked you're still having some--
you're still having a dose and that dose doesn't mean no risk.
It means some risk even if it's a small risk,
but it still means you're going to have a slightly higher risk
than someone who's not exposed to any passive smoke whatsoever.
One thing I was quite astounded by was the number of women
who smoked during pregnancy even after all these years.
So myself and Sadie, that I see
in the audience did a very large systematic review on smoking
and birth defects a couple of years ago and as we looked
into this we put the statistics behind it.
In the U.K. one in seven women,
pregnant women smoked during pregnancy
and a startling statistic in this day and age.
And again, is a social inequality divide,
again the smoking.
And it-- less than 20 years old--
shoot to the next and it's routine and manual work,
many more of those smoke compared to those in manual,
sorry those in managerial professional jobs
and is also a big age gap.
Lots of young women and young girls smoke compared
to older women.
So the one that I found most surprising was women aged
under 20 years old, 45 percent
of those smoked during pregnancy, okay.
It's a huge number.
So some common outcomes of pregnancy, there's miscarriage,
plenty of deaths where the baby has died just before,
sometime just before pregnancy, premature births
and low birth weights.
These aren't minor disorders.
They can be quite stressing to the woman and her partner
and these are not minor in terms of the number of cases
that smoking has caused.
So the number of miscarriages is 5,000 caused
by smoking each year in the U.K.,
19,000 with low birth weights.
So it's a big problem so not heart disease or cancer,
which are common as well.
These are also just as common in some respect.
And one thing we found is the whole range of birth defects
and many of these are lifelong defects,
which you can't fix so readily.
So there's something called gastroschisis where parts
of the abdomen protrudes from the baby's stomach, which is not
so easy to fix, hernia where the skull doesn't fuse properly,
club foot, missing or deformed limbs and legs, a whole range
of defects caused by smoking.
So some milestones over the 50 years,
so that's why the product is so good, why it's bad,
but going through some things
that you might not have known of, known about
and some milestones over the 50 years.
Over the years most countries put a huge effort
into tobacco control and I've just picked out a smattering
of them, ones that I thought were quite interesting.
So, 1962 and 64 the U.S. and the U.K. came
out with their first official government health reports
alarming people about the health hazards of smoking.
Then not so long afterwards 1965 the U.K. I thought was quite
advanced for banning smoking on television.
It took other countries longer than that before they started
to ban it on TV, but the U.K. were very quick
with the mark soon after that first report came through.
And in 1971 an organization called ASH started,
wonderful name of course.
But then many other organizations such as ASH,
but I particularly picked on ASH because they are so good
at their research and getting information out there both
in the U.K. and internationally.
And they're the ones that--
they're quite a thorn in the tobacco industry's foot.
The U.S. Food and Drug Administration came out
and approved nicotine gum in 1984.
The reason I raised that was the tobacco industry were very much
against it for obvious reasons and they actually tried
for that not to be licensed.
But, it's good that it was licensed because it's one
of the effective ways for people to stop smoking.
Nineteen ninety seven, remember Marlboro man in the beginning,
the healthy looking thing, he died of lung cancer,
so it's a not milestone, so I put it up there just
to make sure it's not a good thing.
It was quite sad and it's quite ironic in the same way
that here's their front man for a product
that probably eventually killed him in the end.
And then finally in 2005,
again its seven years ago this thing called the
WHO Convention Tobacco Control,
a huge international concerted effort
to get tobacco habits down internationally.
So some other general achievements,
nonsmoker is now considered the norm.
I mean everyone now thinks this is obvious.
If you go back 10-15 years, that's not the case at all
and smokers very acceptable in many places.
Smoking is now unacceptable in most places
and you see peoples' eyebrows raised
when someone does pull out a cigarette.
Most smokers now want to quit, lots of restrictions
on where people can smoke, advertising bans,
most packets have got cigarette warnings on them
and a combination of that
and other important tobacco control policies have avoided a
large number of people dying.
If the U.K. population and the U.S. and Europe carried
on the way they did you would have a lot more
than 100,000 deaths per year.
So even though it's still a large number it's a large number
that's been avoided in the first place.
So how have smoking habits changed over time?
It's changed a lot from 1974 to 2010, so it's more than halved
in both men and women, but it's, without sounding like a teacher,
it's still not good enough.
You've still got one if five of the population
that are active smokers, so this is the bit that we need
to improve and find ways of improving that.
It still is too much and the reason is
if you do stop smoking it does work.
And in fact, any age that people stop smoking you get some
benefit, so the younger people stop degrades the benefits,
but even if a lifelong smoker decides to stop in their 50's
and 60's they can still get some benefit.
If you look at the curve at the bottom,
that blue curve are people
who continue smoking throughout their life.
That red curve are lifelong nonsmokers and as you can see
that curve in the middle, the dashed blue line,
those are the ones who quit.
So there risk will never be the same as a never smoker,
but it's still going to be better than someone
who continues to smoke, so any age of quitting is worthwhile.
So when people say I'm too old now
to quit it's not really a good reason
and you can still get health benefits from it at the end.
So what next?
Tobacco industry are absolutely stunning
at how they market the product.
I'm still after 20 years in the business amazed at what they do
and they find new innovative ways
of keeping this tobacco product in peoples' minds
and keep it looking attractive.
There needs to be more government funding
for tobacco control even though it's quite a lot at the moment,
it's probably not big enough.
And don't forget prevention is better than cures,
much better to stop people from smoking in the first place
such that they don't get those disorders later on in life
to which most governments then have to treat.
And governments particularly have
to focus the developing countries
where the tobacco epidemic is increasing so a lot
of those deaths you will see
in the future will increase even more in places
like South America, China and India.
China published its anti-smoking plan last year
because they were, not told to, but they felt obliged
to because they're part of this WHO framework.
They want to reduce their prevalence
by 28 percent to 25 percent.
It's not a huge number, but you might think well it's a very
large country, there's a lot of smokers.
But, they're not taking the advice of this,
of the WHO organization.
They're going their own way, so we're not--
we're a bit doubtful on how effective this is going to be.
Three hundred million smokers in China alone
and this is why it's going to be an uphill struggle in China.
When there was an earthquake in China a few years ago
in the Sichuan region a year later the tobacco company
sponsored and setup 100 schools, okay.
And can you see those Chinese lettering?
The first line means genius comes from hard work.
That's quite good isn't it
for your young children, yes, very happy.
Second line means tobacco helps you to be successful.
[Laughter] So this is on the front of the school in 2009
so when the children come
into school these are the two phrases they see.
You need to be-- you can be good at what you do, but to help you
to be good at what you do, smoke.
So can you think how wonderful the tobacco companies are,
but also the-- like I said the idiocy of the local government
that allowed this to take place in the first place.
So it was an uphill struggle,
tobacco control policymakers have in developing countries
when you've got this still being done in this day and age.
This is also, this is Australia,
so they have cigarette packets have been shortlisted
for the Design of the Year Award.
So look at the packets, tell me what you think.
What's it look like?
What's missing from the packets?
It's the branding, okay.
It's-- the maker of the cigarette company's hidden
and these packets have been deliberately designed
to look unattractive, unappealing.
And they actually did market research that showed
that olive green is the least attractive color for customers.
So they really put it on thick here,
which is why it was selected to be design product of the,
a design award of the year because it's encompassed all
of these things and some people actually think it looks quite
beautiful because it gives you so much information
and it takes away all the appeal.
But, if you compare this, the previous slide
where you've got tobacco it makes you successful you can see
the disparity in the world today and where we are.
What next?
The Royal College of Physicians suggested access
to other nicotine products.
This is not ideal of course, so things like snuffs
that you can get in parts of Sweden,
but those other nicotine products are much safer
than cigarettes.
So if people can't kick their nicotine habit rather than carry
on and smoking find a much safer alternative
and hopefully wean them off later on.
More protection for children of smokers:
I still commonly see small children
with their parents standing over them puffing,
blowing their smoke at them more often
than I should be seeing really.
And that goes back to that figure
of where you got 40 percent of, 45 percent of young women
who smoke during pregnancy.
They're going to smoke during pregnancy and they're going
to smoke afterwards as well.
Better coordinated cessation programs are required
for tobacco control.
And one of the areas that people are going to look
at more are mental health disorders where the smoke
and prevalence is quite high,
much higher than the general population.
And more smoke free policies especially
in developing countries, but this can only come
by local governments and the big governments supporting these
tobacco control policies.
More legislation and restrictions
so you might say oh God more laws
like we haven't got enough already, but they do work
and when you've got a huge problem
such as tobacco smoking you need radical ideas.
If you go back 50 years the thought of having a smoking ban
in most places would seem quite unreal.
Now, everyone accepts it.
It's been passed a norm so you need radical thinking now
for things to be accepted as normal in the future.
Did the legislation in the U.K. affect businesses
because you have lots of people saying that it would
and of course the tobacco industry said it would?
It didn't.
So the U.K. Department of Health did some surveys
and they actually found the effect on businesses
and licensed businesses had more
of a positive impact than a negative one.
And whenever you see those studies where the two things,
there's two columns are switched the way around,
guess who funds those, the tobacco company.
But, when you have an unbiased study on what the effects
of legislation is there's a consistency
that the businesses have done better or there have no change,
but very few of them said they had done worse.
So the final slide, two ultimate goals, more and more smokers
to quit and discourage people from taking up the habit
in the first place and only
with those two together can we stop this huge number of deaths
and or so morbidity and that's going to get higher and higher
in developing countries.
So National No Smoking Day was yesterday.
You may or may not have realized.
I didn't see much of it on the TV and World No Smoking Day
in a few months' time.
Thank you.
[ Applause ]
>> Well thank you very much Allan.
Yes there is time for questions.
Let's see if there's any questions coming now.
And when you ask the question can you hang
on for the microphone until we--
can you hang on to the microphone to get to you?
>> How much do you think the western government are
responsible for encouraging the tobacco smoking
in third world countries and you mentioned China too?
>> Allan Hackshaw: I'm not sure actually.
I think this is a manufacturing now for China,
it's done in China and some of the U.K. Governments.
I'm not sure.
They're supposed to be anti-smoking,
but even Australia, which is very anti-smoking the tobacco
industry still has quite a sway.
It's quite powerful so I imagine there's a similar effect here
in the U.K. with the tobacco companies on U.K. legislation.
So I think things can-- the smoking ban, for example,
probably could have been quicker.
In terms of their impact elsewhere I don't know.
I hope it's minimal.
[ Laughter ]
[ Silence ]
>> At the back there.
[ Silence ]
>> Thank you very much.
It was very interesting and endorsed everything I felt.
When I was young there used to smoking cinemas
and if you mentioned anything there would something equivalent
to road rage.
And then I noticed when they stopped people smoking
in restaurants and they kept one or two tables
and you would mention, oh could you stop smoking I have a child
with me.
There would be another road rage.
The question I wanted to ask when--
I've always hated smoking.
I did smoke for one year, my last year
when I was doing my undergraduate law degree we all
smoked like crazy and then I stopped.
>> Allan Hackshaw: Great.
>> And I had a theory-- this was my question, I had a theory
that if you buy a packet of cigarettes,
this is how I stopped and threw that packet away rather
than saying I'll stop when I've finished the cigarettes
that was the best way to stop.
The question, which I rambled a bit, is consultants
when somebody's dying of lung cancer they always tell the
family oh it's nothing to do with smoking
and that's why I found your talk so refreshing.
You were not saying that.
I have friends who've smoked all their lives
and they've got arthritis.
One of my best friends, her-- she's the same age as me.
She only goes up and down the stairs three times a day
as her exercise.
Another one smoked all her life.
She goes to bed with a bugroll every night, has to sit up.
And yet when I used to say stop they would say oh your bike.
Go away. I'm not interested.
You know it was really refreshing
to hear you actually come out with-- sorry I went on so long-
>> Allan Hackshaw: That's fine.
I think it's quite a start.
I mean if someone does get lung cancer you can't say
for sure it is due to smoking,
but the chances are that it actually is.
And that's the thing; it's not just cancer and heart disease.
There's a whole host of other things and the chronic disorders
that you can get as well at the same time.
>> You didn't mention arthritis.
>> Allan Hackshaw: No I just put a smattering of ones up here,
but arthritis I'm sure would be one of them as well.
>> A question there.
>> You mentioned links or potential links
to mental illness to smoking.
I was just wondering what mental illnesses might,
there might be a causal link to?
>> Allan Hackshaw: There's some evidence that it--
anxiety, people think that, smokers think
that it's better for stress.
There's actually some evidence
that it can make you more anxious.
Example, there's a link between schizophrenia
and postpartum depression
and there's a [Inaudible] report coming out later this year
that I was involved in
and that's going to summarize it all.
So there's actually quite a few.
But, it's been an area that people have ignored so long
because people in mental care homes, for example,
even if the prevalence might be as high
as 40-50 percent the view was well it helps keep them calm.
Well it might help them feel calm,
but then you've got all these other disorders they might get
as well.
>> The next question is just over there, oh sorry.
[ Inaudible background question ]
>> Allan Hackshaw: Yes there are and they're going
to be summarized in this report this year.
>> Fine, and then that one over there.
>> Could you be more specific from your vantage point
on what might usefully be done in the U.K.
to reduce smoking further?
For example, given your emphasis
on the tobacco companies should there be a directed initiative
against their activities?
And again, for example, there seems to be a shift of smoking
from banned environments to the periphery, for example,
railway stations and doorways of workplaces.
And a further idea, could the litter associated
with cigarette ends be a basis for targeted measures?
>> Allan Hackshaw: I think all of those--
when the smoking ban was first developed several years
and I was partly involved in that as well.
The thought of banning smoke in parks,
for example, I thought how weird.
Why would you ban smoking in a public are such as that?
But you-- when I think of it now it partly makes sense.
It's to stop smoking everywhere really
and to help smokers think well it's not so easy to smoke
in lots of these places.
In terms of other policies you could--
the price of cigarettes could probably--
it can still go up and there is a direct relationship
between as the price gets higher smoke--
there are less smokers or they smoke less.
So even though you think a packet
of cigarettes might be expensive now it can still go higher.
In fact, in real terms a packet, people still spend, people spend
as much as they were many years ago.
So for you to out price it is one of the ways
and the protection of the children is another one.
So trying to stop people from smoking in cars that carry kids,
this might be another way
that I thought was too radical a couple of years ago.
But again, I now see as not something in its own right,
which might look strange, but as a whole package of policies.
>> The question over there.
>> Do you liken as a danger in putting up the price
of cigarettes when a lot
of people are low income families are buying those,
sort of a danger of putting the price up
and the parents will still buy them, but children sort
of do less well, have less money to spend?
>> Allan Hackshaw: That is an issue.
I'm not sure.
There might be evidence of it.
But, we do know that as you put the price up people do quit.
So there's going to be a balance between how much do people quit
and how much do the children, for example, suffer.
I think one question you could ask is how high could it go
before people think it's so high I really can't afford this?
I need to buy clothes and food for the family.
I don't think anyone's really pushed the limit yet
and the tobacco-- I think there's one example
where the tobacco companies do try and keep the price back.
>> There's time for just that one more.
That's just-- yea.
>> Hello. Thank you very much.
I just wondered whether you include
in your research other forms of tobacco, cigars, pipe smoking
because you haven't mentioned those at all.
>> Allan Hackshaw: Same thing applies to cigar,
cigarettes because they're the most common one
and it still applies to cigars and pipe smoking.
>> Do you include those in your figures?
>> Allan Hackshaw: They usually are, yes.
So whenever you see smoking it usually means all forms
of smoking unless it specifically says,
it states cigarette smoking.
>> I'm sorry I have to close it now.
We have to exit by five minute to.
So just make-- thank you very much indeed Allan
for a data loaded case.
Thank you very much indeed.
[ Applause ]